OBJECTIVES:To develop and validate the Internalised Stigma Scale for Gestational Diabetes Mellitus (ISS-GDM), a questionnaire measuring self-reported internalised stigma among women with prior gestational diabetes mellitus (GDM). We hypothesised that internalised GDM stigma could be reliably and validly assessed through a short psychometric instrument. DESIGN:Cross-sectional validation study. SETTING:Follow-up data from the Danish, multicentre Face-it trial for women with prior GDM and their families. PARTICIPANTS:In total, 248 women completed the ISS-GDM approximately 1 year after their GDM affected pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome was psychometric properties of the ISS-GDM, assessed using Cronbach's alpha, confirmatory factor analysis (CFA) and Rasch analysis (RA). Secondary outcomes included identification of item anomalies (local response dependence, differential item functioning). RESULTS:A large proportion of respondents endorsed statements reflecting self-disappointment, self-blame and an altered self-perception. Less endorsed statements included feeling inferior to other mothers or guilt towards family members due to GDM. The ISS-GDM demonstrated satisfactory psychometric properties. CFA indicated that item 2 assessing self-perceived capabilities as a mother did not load onto the main factor, while CFA and RA identified local response dependence and differential item functioning by body mass index. After adjustments, a two-factor solution supported calculating a sum score of items 1 and 3-11, with item 2 retained as a stand-alone indicator of perceived parenting capabilities. The 10-item scale demonstrated acceptable reliability (Cronbach's alpha=0.78). CONCLUSIONS:The ISS-GDM is a reliable and valid tool for assessing internalised stigma among women with prior GDM. Our findings further suggest that a substantial proportion of women with prior GDM experience self-blame and an altered self-perception due to their diagnosis. The ISS-GDM scale enables research into its prevalence, severity and consequences.

Despite advancements in diabetes management with diabetes technologies, a large proportion of pregnant individuals with type 1 and type 2 (pre-existing) diabetes do not achieve the recommended glycaemic targets, resulting in a high risk of adverse pregnancy outcomes including fetal overgrowth. Novel approaches for diabetes management are urgently needed, and animated videos are increasingly recognised as effective tools for delivering health information across health literacy levels. This study aims to evaluate the impact of adding animated educational videos, available via a smartphone application (app), to usual care, compared to usual care alone, on fetal growth in pregnant individuals with pre-existing diabetes. This national, multicentre, parallel group, open-label randomised controlled trial (RCT) is nested within the Danish Diabetes Birth Registry 2 (DDBR2) study, which includes pregnant individuals with pre-existing diabetes and their offspring. Individuals who consent to participate in the DDBR2 study and fulfil in- and exclusion criteria are enrolled before 14 weeks of gestation, randomised 1:1 and followed until 1 month after delivery. For this study, 15 animated educational videos (1–5 min) were developed using a three-stage framework involving iterative stakeholder input from experts, the target group, and an animation/film director. The videos contain evidence-based information on diabetes self-management in pregnancy. In addition to usual care, the intervention group receives unlimited access to these videos through the “Pregnant with Diabetes” smartphone app, whereas the control group receives usual care alone. Randomisation stratifies for diabetes centre, diabetes type, and the use of multiple daily injections or insulin pumps in individuals with type 1 diabetes. The primary outcome is offspring birth weight standard deviation score. Data analysis will follow the intention-to-treat principle. This study is expected to provide valuable evidence for improving diabetes management during pregnancy for individuals with pre-existing diabetes. The strengths of this large RCT are the involvement of experts and the target group in the development of the intervention and the comprehensive evaluation of fetal outcomes. However, a lack of a systematic mechanism to encourage the use of the intervention may impact its effectiveness. ClinicalTrials.gov NCT06250192. Registered on February 1, 2024

Research on gestational diabetes mellitus has mainly focused on glucose metabolism, but improving glycemic control has not eliminated the complication rate in these pregnancies. The aim of this study was therefore to investigate how other metabolic and cardiovascular risk factors in women with gestational diabetes mellitus contribute to adverse pregnancy outcomes, thereby giving a more nuanced characterization of maternal metabolic status and the effects on fetal outcome. This cohort study included mother-infant pairs with maternal gestational diabetes mellitus (n = 722) in the Central Region of Denmark from 2019 to 2022. Anthropometric and metabolic data were collected during a pregnancy visit at week 34–38. Offspring data were collected from an audit of the participants’ medical records. Large for gestational age (LGA) was defined as birth weight above the 90th centile for gestational age and sex. Logistic and linear regression were performed to determine the association between maternal metabolic cardiovascular risk factors and adverse pregnancy outcomes. Analyses were adjusted for age, ethnicity, and parity. Exposures unrelated to weight were adjusted for pregestational body mass index. Furthermore, outcome rates were stratified by treatment (insulin vs. diet-only). This study found increased odds for LGA with pre-pregnancy body mass index ≥ 30 kg/m2 (adjusted odds ratio (aOR)) = 2.26 [1.37;3.73]), increasing diagnostic oral glucose tolerance test 2-h glucose value (aOR = 1.20 [1.05;1.38]), 3rd trimester total cholesterol (aOR = 1.25 [1.05;1.49]), 3rd trimester triglycerides (aOR = 1.28 [1.07;1.53]), 3rd trimester HbA1c (aOR = 1.13 [1.07;1.18]), high gestational weight gain (aOR = 1.76 [1.07;2.87]), and insulin-treatment compared to diet-only treatment (risk ratio = 2.51[1.89;3.33]). Strong associations between pre-pregnancy body mass index, glycemic measures, and lipid profiles with adverse neonatal outcomes, particularly large for gestational age, underscore the importance of a broader risk assessment in women with gestational diabetes mellitus, not only based on glycemic parameters but also including weight prior to and during pregnancy and lipid status.

Blood pressure is regulated in part by circadian rhythms, and melatonin has been reported to exert blood pressure–lowering effects. The underlying mechanisms, however, remain unclear. We hypothesized that melatonin would lower blood pressure in individuals with type 2 diabetes with or without hypertension, and that this effect would be mediated by a reduction in arterial stiffness. We conducted a double-blinded, randomized, placebo-controlled crossover trial involving 17 individuals with type 2 diabetes. Participants completed two treatment phases: three months of 10 mg melatonin taken one hour before nighttime, and three months of placebo taken at the same time separated by a four-week washout period. On the last day of each period, participants underwent 24-hour ambulatory blood pressure monitoring, including measurement of arterial stiffness, using the Arteriograph 24. Fifteen participants completed the 24-hour ambulatory blood pressure monitoring (hypertension n = 6). Melatonin treatment was associated with numerical, non-significant reductions in mean nighttime systolic blood pressure (-6 [-13:1] mmHg, p = 0.08, ≈ 5

Women with pre-existing diabetes face a markedly increased risk of adverse pregnancy outcomes. Advances in diabetes management and a rising prevalence of type 2 diabetes during pregnancy underscore the need to reassess the effectiveness of care provided before conception. This review examined the impact of such care on maternal and perinatal outcomes in pregnancies affected by type 1 diabetes or type 2 diabetes. We systematically identified studies comparing women who received structured care before conception with those who did not. Two reviewers independently screened records, extracted data, and assessed risk of bias. Owing to substantial heterogeneity in study design and definitions of care, findings were synthesized narratively by outcome domain and diabetes type. Fiftyone studies were included, predominantly involving women with type 1 diabetes or populations including both diabetes types. Pre-pregnancy care was consistently associated with lower glycated hemoglobin levels in early pregnancy, while differences later in gestation were smaller and less consistent. Several studies suggested reduced risk of congenital malformations and perinatal mortality, though results varied and were often constrained by sample size and residual confounding. Pre-pregnancy care may also facilitate earlier antenatal care and reduce miscarriage risk, whereas evidence for other maternal and neonatal outcomes was inconsistent. Pre-pregnancy care remains an important strategy for improving outcomes in pregnancies complicated by pre-existing diabetes despite advances in diabetes care. However, effect estimates varied across studies, and evidence in type 2 diabetes was particularly limited, underscoring the need for contemporary studies focusing on this growing population.

BACKGROUND:Healthy diet is essential to reduce the increased risk of developing type 2 diabetes mellitus (T2DM) among women with previous gestational diabetes mellitus (GDM). OBJECTIVES:This study investigates dietary changes and predictors of dietary improvement during first year after childbirth among women with GDM. METHODS:This post hoc longitudinal analysis used data from the Face-it randomized controlled trial, which evaluated a health promotion intervention for women with recent GDM. As the intervention had no effect on diet, data from both intervention and usual care groups were pooled, collected at baseline and follow-up (3 and 12 mo after childbirth). Dietary quality score (DQS) was used to assess self-reported dietary habits. Predictor variables included body mass index (BMI), risk perception of T2DM, self-perceived dietary habits, social support, breastfeeding status, and mental well-being. Paired t-test and ordinal logistic regression adjusted for randomization group were conducted. RESULTS:This study included 232 women. The overall mean DQS did not change from baseline to follow-up; however, 66% women modified their dietary quality, with an equal split between improvement and decline. Higher odds of dietary improvement were seen in women with baseline BMI ≥30 kg/m2 [odds ratio (OR): 3.29; 95% confidence interval (CI): 1.60, 6.80] and BMI 25-29.9 kg/m2 (OR: 2.41; 95% CI: 1.28, 4.54) compared with those with a BMI <25 kg/m2. Women who perceived their diet as unhealthy had increased odds of improvement compared with those who perceived it as healthy (OR: 3.84; 95% CI: 1.40, 10.56). Fully breastfeeding women at baseline had lower odds of dietary improvement than nonbreastfeeding women (OR: 0.39; 95% CI: 0.18, 0.84). No associations were found for risk perception of T2DM, social support, and mental well-being. CONCLUSIONS:Dietary patterns after a GDM-affected pregnancy are heterogeneous, underscoring the importance of tailored dietary interventions addressing individual needs to improve dietary quality and reduce the risk of T2DM.

OBJECTIVES:Adhering to dietary recommendations after gestational diabetes mellitus (GDM) can mitigate the risk of early-onset type 2 diabetes. Psychosocial aspects, such as health literacy and perceived stress, may affect adherence to these recommendations; yet this remains underexplored in women with recent GDM. This study aimed to examine the association between health literacy and dietary quality 10-14 weeks postpartum and to assess the influence of perceived stress. STUDY DESIGN:Cross-sectional study. METHODS:This study used baseline data from the Face-it trial, including 283 Danish women with recent GDM 10-14 weeks postpartum. Dietary quality was measured using the Dietary Quality Score (DQS), health literacy using two domains of the Health Literacy Questionnaire: HLQ-2 (Having sufficient information to manage my health) and HLQ-3 (Actively managing my health), and stress using the Perceived Stress Scale (PSS). Multiple linear regression examined the association between HLQ-2 and DQS, and HLQ-3 and DQS, adjusting for age, education, and country of birth. Additional analyses examined the influence of perceived stress. RESULTS:Among women with recent GDM, reporting Having sufficient information to manage their health (HLQ-2) and Actively managing their health (HLQ-3) were positively associated with dietary quality, with βadjusted = 0.55 [95 % CI: 0.22-0.87] and βadjusted = 1.12 [95 % CI: 0.84-1.41], respectively. Perceived stress did not affect these associations. CONCLUSION:Health literacy was positively associated with dietary quality among Danish women with recent GDM. Stress did not affect this association.

This study aimed to investigate how pre-meal whey protein (WP) supplementation throughout the third trimester of pregnancy affects glycaemic and metabolic outcomes in women with gestational diabetes mellitus (GDM). The hypothesis was that WP, when administered as a pre-meal 30 min before breakfast daily, lowers glycaemic variability (primary outcome: CV www.randomiser.org ) to WP or placebo using a computer-generated list. Allocation was concealed with sealed strips. Participants, caregivers, investigators and outcome assessors were masked, except the dietitian providing dietary guidance. Eligibility criteria included GDM, normotension and age ≥18 years. Exclusion criteria included special dietary regimens ≥1 month, daily protein supplements, food allergies, glucose-metabolism-affecting drugs, twin pregnancies, polycystic ovary syndrome, severe comorbidity, hyperemesis or non-breakfast eaters. The study included laboratory visits, home-based measurements under controlled-living and free-living conditions during the early and late third trimester, and follow-up at delivery. Glucose levels were assessed using continuous glucose monitoring. A total of 29 women were randomised to placebo and 33 were randomised to WP, with 25 in the placebo group and 30 women in the WP group completing the study. In the WP group, the 1 h postprandial glucose following breakfast was −20

AIMS:We evaluated the fidelity of the Face-it intervention and its impact on behaviour change mechanisms among women with recent gestational diabetes mellitus (GDM). METHODS:In this randomised controlled trial, 277 women were allocated to usual care or an intervention comprising three home visits, digital platform health coaching and cross-sectoral communication to support health behaviour change during the first year after delivery. Behaviour change mechanisms included social support, motivation, self-efficacy, risk perception and health literacy. High fidelity was defined as completing three home visits and ≥ 9 coaching contacts. RESULTS:Within the intervention group, 86.4 % completed ≥ 2 home visits, 88.6 % registered digitally with a median (IQR) of 10.0 (3.0-20.0) contacts. At one-year after delivery, the high-fidelity group (n = 73; 39.7 %) had higher odds of perceiving moderate/high diabetes risk (OR 2.42; 95 % CI 1.06-5.51) and higher health literacy (adjusted difference 0.20; 95 % CI 0.04-0.35), whereas no difference was found for social support, motivation and self-efficacy compared with usual care. No difference was observed between the low fidelity and the usual care group in behaviour change mechanisms. CONCLUSIONS:The Face-it intervention achieved acceptable fidelity. High fidelity appears essential for improving risk perception, health literacy and supporting behaviour change mechanisms among women with recent GDM.

Background: Rapid infant growth is positively, and breastfeeding inversely, associated with childhood overweight. However, the interplay has only been sparsely investigated. Objectives: We aimed to investigate how exclusive breastfeeding duration modifies the effect of infant growth on childhood overweight. Methods: We included routinely collected data on duration of exclusive breastfeeding and child growth from Aarhus Municipality, Denmark and on maternal health from the patient records at Aarhus University Hospital, 2008-2013. Infant growth was estimated using latent class analysis. Duration of exclusive breastfeeding was grouped as never, <= 4 mo, and >4 mo. Childhood overweight was defined as a body mass index z-score >1 at age 5 to 9 y. We investigated the risk of overweight dependent on infant growth and breastfeeding duration both independently and combined using logistic regression and adjusting for potential confounders. Results: Among 7074 infants, we identified 3 growth patterns: average, accelerated, and decelerated. No or <= 4 mo of breastfeeding was associated with being overweight at 5 to 9 y (adjusted odds ratio [aOR]: 1.61; 95% confidence interval [CI]: 1.27, 2.03 and aOR: 1.54; 95% CI: 1.28, 1.85, respectively) compared to >4 mo of breastfeeding. Compared with average infant growth, accelerated growth was associated with childhood overweight (aOR: 1.35; 95% CI: 1.01, 1.79). In the combined analysis, accelerated infant growth showed no evidence of being associated with overweight if infants were exclusively breastfed >4 mo (aOR: 1.20; 95% CI: 0.68, 2.10). Decelerated growth was not associated with overweight regardless of exclusive breastfeeding duration, compared with infants with average growth who were exclusively breastfed >4 mo. Conclusions: Longer duration of exclusive breastfeeding was associated with decreased risk of being overweight, whereas accelerated infant growth was associated with increased risk. Children with accelerated infant growth who were never breastfed had the highest risk of being overweight at 5 to 9 y of age, whereas there was no association if infants were exclusively breastfed >4 mo.

AIMS:Pregnant women are occasionally misdiagnosed with gestational diabetes (GDM) when they may have glucokinase monogenic diabetes (GCK-MODY). Differentiating between GCK-MODY and GDM is critical due to the distinct treatment strategies required during and after pregnancy. Since pregnancy often elicits the first glucose tolerance test, it provides a unique opportunity to identify individuals with GCK-MODY. However, testing all pregnant women with GDM for GCK-MODY is expensive, and the use of clinical criteria is warranted. An Irish study suggested using a combined criteria of a pre-pregnancy body mass index (BMI) <25 kg/m2 and fasting glucose ≥5.5 mmol/L to differentiate GCK-MODY from GDM. Therefore, we aimed to identify women with GCK-MODY during pregnancy using these combined criteria in a Danish population of women with GDM. Additionally, we aimed to screen for other MODY subtypes. METHODS:We recruited women from the Central Denmark Region diagnosed with GDM between April 2019 and December 2022. Women meeting the criteria of pre-pregnancy BMI <25 kg/m2 and fasting glucose ≥5.5 mmol/L were offered screening for MODY (17 known genetic variants) using Illumina's Next Generation Sequencing. RESULTS:Of the 1270 women with GDM, 46 met the MODY screening criteria. Of these, 41 were offered MODY screening, 34 participated and 1 woman was identified with MODY (MODY 8-CEL variant). CONCLUSION:The current Danish GDM screening guidelines do not apply with recommending the use of pre-pregnancy BMI <25 kg/m2 and fasting glucose ≥5.5 mmol/L as criteria for identifying women with GCK-MODY among women with GDM in the Danish population.

OBJECTIVE:To examine how whey protein served as a premeal affects postprandial glucose excursions in women with gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS:A placebo-controlled, single-blinded, crossover, randomized trial including women with and without GDM (20-36 weeks' gestation) was performed. Participants were studied in the laboratory and at home. In the laboratory, women were randomized to consume 20 g of whey or placebo 30 min before undergoing, 7-14 days later, a 75-g oral glucose tolerance test (OGTT). Blood was sampled consecutively 3 hours following the OGTT. The primary end point was the incremental area under the curve (iAUC) for glucose. At home, participants wore continuous glucose monitors and, on subsequent days, randomly consumed 0, 10, 15, 20, and 30 g of whey 30 min before breakfast. RESULTS:Twelve women with GDM and 12 pregnant women with normal glucose tolerance (NGT) to part in the trials. Intake of premeal whey resulted in lowered peak glucose by -1.0 mmol/L (95% CI -1.6 to -0.4) in women with GDM and -0.7 mmol/L (95% CI -1.3 to -0.1) in women without GDM compared with placebo. Insulin, glucose-dependent insulinotropic polypeptide, and glucagon-like peptide-1 levels increased rapidly after whey consumption in both groups. At home, a premeal of 30 g of whey dose-dependently reduced incremental glucose peaks with a maximum of -2.0 mmol/L (95% CI -2.5 to -1.5) in women with GDM compared with placebo. CONCLUSIONS:Premeal whey consumption acutely lowers postprandial blood glucose in women with GDM and those with NGT, with 15-30 g lowering the glucose iAUC of women with GDM. These findings emphasize the need for long-term studies to assess the impact of whey premeals in pregnancies affected by GDM.

AIMS:This study investigated the prevalence and concordance of cardiometabolic risk markers among couples after a gestational diabetes mellitus (GDM)-affected pregnancy. It also examined whether selected demographic, socioeconomic and health behavioural factors could explain within-couple associations. MATERIALS AND METHODS:A cross-sectional study design was used. We included health examinations and questionnaire data from couples assessed 12 weeks after a pregnancy affected by GDM. We determined the prevalence and concordance of cardiometabolic risk markers (overweight or obesity, high waist circumference, metabolic syndrome, impaired fasting glucose [≥6.1 mmol/L], and stage 1 hypertension or more [≥130 mmHg/≥80 mmHg], along with health behaviour [dietary quality and physical activity]). RESULTS:A total of 196 couples were included. Overweight or obesity was present in 63.3% of women and 71.9% of partners, with concordance observed in 50.5% of couples. By comparison, 78.6% of women and 55.1% of partners had high waist circumferences, which was concordant in 48.5% of couples. Metabolic syndrome was identified in 9.2% of women and 24.0% of partners, suggesting a higher occurrence among partners with concordance in 5.1% of couples. Impaired fasting glucose was observed in 7.7% of women and 9.2% of partners, with concordance in 1.5% of couples. Stage 1 hypertension or more was observed in 31.1% of the women, 55.6% of the partners and concordant in 8.2% of couples. Cardiometabolic risk markers were associated within couples. CONCLUSIONS:Detecting GDM in women may serve as an opportunity to identify partners at risk, underscoring the potential of couple-based or family-focused interventions.

AIMS:To compare markers of glycaemic regulation in twin and singleton pregnancies in women with gestational diabetes mellitus (GDM). METHODS:A retrospective case-control study was performed. 53 twin and 212 matched singleton pregnant women with gestational diabetes were included. Data were obtained from patient files. Twin and singleton pregnant women were compared regarding clinical characteristics and parameters related to glucose metabolism. RESULTS:Compared to singleton pregnant women, twin pregnant women were diagnosed with GDM earlier in pregnancy (gestational age (GA) (weeks + days) 24 + 5 ± 5 + 2 vs. GA 27 + 2 ± 5 + 2; p = 0.002). The proportion of women treated with insulin was similar (24.1% vs. 24.5%, p = 1.0), but in twin pregnancies, insulin treatment was commenced earlier (GA 25 + 2 ± 4 + 6 vs. GA 30 + 1 ± 5 + 0; p = 0.003). At diagnosis, the HbA1c value was significantly lower in twin pregnant women (34 (5.3) ± 4.8 (2.6) vs. 35.9 (5.4) ± 5.4 (2.6), p = 0.03), but mean HbA1c values were similar in 2nd (33.9 (5.3) ± 4.6 (2.6) vs. 35.7 (5.4) ± 5.3 (2.6), p = 0.16) and 3rd trimester (35.1 (5.5) ± 4.2 (2.5) vs. 36.0 (5.4) ± 5.1 (2.6), p = 0.25). CONCLUSIONS:We have characterized the effect of twin pregnancy on parameters of glucose metabolism and glycaemic control in GDM in one of the largest studies of twin pregnant women with GDM to date. We conclude that twin pregnant women may have the GDM diagnosis earlier, but diurnal insulin requirements and HbA1c levels are comparable with singleton pregnant women.

Context:The prevalence of type 2 diabetes (T2DM) in pregnancy is increasing rapidly worldwide. Consequently, there is a need to gain more knowledge about pregnant women with T2DM. Objective:The current study aimed to assess the prevalence of cardiometabolic risk factors and comorbidities in women with T2DM before and during pregnancy, and to evaluate associations with adverse obstetric and perinatal outcomes. A comparison between women with preexisting T2DM (P-T2DM) and women with T2DM first recognized during pregnancy (N-T2DM) was also performed. Design:A retrospective Danish national population-based cohort study, including all pregnancies in women with T2DM, giving birth to a live infant after 24 weeks of gestation, from 2004 until 2019. Results:The population included 1297 pregnancies in women with T2DM (1207 P-T2DM, 90 N-T2DM). Before pregnancy, 20.4% smoked, 13.4% had chronic hypertension, 12.5% had dyslipidemia, and 63.1% had obesity. Only 58.6% of women with P-T2DM entered pregnancy with hemoglobin A1c (HbA1c) < 53 mmol/mol (7.0%). During pregnancy, 73.4% had an excessive weight gain, and 21.6% attained a median HbA1c < 38 mmol/mol (5.6%). Preeclampsia was observed in 9.1% of women, preterm delivery in 19.0%, and large-for-gestational-age birthweight in 32.2% of infants. Obstetric and perinatal outcomes were similar in women with P-T2DM and N-T2DM. All modifiable exposures were associated with one or more severe adverse outcomes. Conclusion:Cardiometabolic risk factors are prevalent in pregnant women with T2DM and are associated with severe adverse outcomes for mother and child.

Introduction Despite technological developments and intensified care, pregnancies in women with pre-existing diabetes are still considered high-risk pregnancies. The rate of adverse outcomes in pregnancies affected by diabetes in Denmark is currently unknown, and there is a limited understanding of mechanisms contributing to this elevated risk. To address these gaps, the Danish Diabetes Birth Registry 2 (DDBR2) was established. The aims of this registry are to evaluate maternal and fetal-neonatal outcomes based on 5 years cohort data, and to identify pathophysiology and risk factors associated with short-term and long-term outcomes of pregnancies in women with pre-existing diabetes.Methods and analysis The DDBR2 registry is a nationwide 5-year prospective cohort with an inclusion period from February 2023 to February 2028 of pregnancies in women with all types of pre-existing diabetes and includes registry, clinical and questionnaire data and biological samples of mother–partner–child trios. Eligible families (parents age ≥18 years and sufficient proficiency in Danish or English) can participate by either (1) basic level data obtained from medical records (mother and child) and questionnaires (partner) or (2) basic level data and additional data which includes questionnaires (mother and partner) and blood samples (all). The primary maternal outcome is Hemoglobin A1c (HbA1c) levels at the end of pregnancy and the primary offspring endpoint is the birth weight SD score. The DDBR2 registry will be complemented by genetic, epigenetic and metabolomic data as well as a biobank for future research, and the cohort will be followed through data from national databases to illuminate possible mechanisms that link maternal diabetes and other parental factors to a possible increased risk of adverse long-term child outcomes.Ethics and dissemination Approval from the Ethical Committee is obtained (S-20220039). Findings will be sought published in international scientific journals and shared among the participating hospitals and policymakers.Trial registration number NCT05678543.

Childhood obesity is a significant global health issue with complex and multifactorial origins, often beginning before conception and influenced by both maternal and paternal health. The increased prevalence of prepregnancy obesity and gestational diabetes mellitus in women of reproductive age contributes to a heightened risk of metabolic dysfunction in offspring. Current clinical practices often implement lifestyle interventions after the first trimester and have limited success, implying that they miss a critical window for effective metabolic adjustments. This review examines the limitations of lifestyle interventions during pregnancy in improving perinatal outcomes and highlights the importance of initiating such interventions before conception to positively impact parental health and fetal development. A re-evaluation of strategies is needed to enhance the metabolic health of prospective parents as a preventive measure against childhood obesity.

BackgroundThere is an increasing focus on the first 1000 days from conception to two years of age as a period of importance for future weight. We aimed to describe the interaction between fetal and infant growth and their association with and ability to predict childhood overweight.MethodsWe used routinely collected fetal growth data from Aarhus University Hospital and child growth data from Aarhus Municipality, 2008-2018. The outcome was overweight at age 5-9 years. The fetal growth rates at weeks 28 and 34 were extracted from individual trajectories using mixed models. We identified patterns of infant BMI Z-score growth using latent class analysis and estimated odds ratios of overweight at age 5-9 years dependent on fetal and infant growth. Predictive capabilities were assessed by comparing areas under the ROC-curves (AUCROC) of the prediction models.ResultsIn 6206 children, we identified three infancy growth patterns: average, accelerated, and decelerated growth. We found 1.09 (95% CI: 1.06-1.12) greater odds of being overweight for every 10 g/week increase in fetal growth rate at week 34. Compared with average growth, accelerated infant growth was associated with 1.52 (95% CI: 1.20-1.90) greater odds of overweight. Combining fetal and infant growth, children with average fetal growth and accelerated infant growth had 1.96 (95% CI: 1.41-2.73) greater odds of overweight. Fast fetal growth with decelerated infant growth was not associated with being overweight (OR: 0.79 (95% CI: 0.63-0.98)), showing that infant growth modified the association between fetal growth and overweight. When fetal growth was added to a prediction model containing known risk factors, the AUCROC remained unchanged but infant growth improved the predictive capability (AUCROC difference: 0.04 (95% CI: 0.03-0.06)).ConclusionFetal and infant growth were independently associated with overweight, but distinct combinations of fetal and infant growth showed marked differences in risk. Infant, but not fetal, growth improved a prediction model containing known confounders.